Effects of Ketamine on Intracranial Pressure in Children With Severe Traumatic Brain Injury
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Neuroscience, Pharmacology, Pediatrics, 2022
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INTRODUCTION/HYPOTHESIS: Ketamine has traditionally been contraindicated in traumatic brain injury (TBI) because it is thought to raise intracranial pressure (ICP). However, more recent studies have challenged this. Also, current guidelines do not provide recommendations regarding ketamine in pediatric severe TBI. We used high-frequency monitor data to evaluate the effect of ketamine on ICP in children with severe TBI. We hypothesized that ketamine would not raise ICP and could potentially lower ICP when used in treatment of elevated ICP. METHODS: Data was retrospectively collected from ICP-monitored pediatric severe TBI patients treated at a quaternary care pediatric intensive care unit according to Brain Trauma Foundation guidelines, including treatment of ICP > 20mmHg for >5 minutes. Demographic and clinical data were recorded, including age, sex, admission Glasgow Coma Scale score, mechanism of injury, surgical decompression, and survival to discharge. Cerebral perfusion pressure (CPP) and ICP were recorded in an automated database at 1-minute intervals. Administration times of bolus medications for treatment of intracranial hypertension (3% saline, fentanyl, and ketamine) were synchronized with ICP and CPP recordings. ICP and CPP were compared each minute for 10 minutes after each ketamine administration, vs. baseline. For the subset of ketamine, 3% saline, and fentanyl doses given for ICP > 20mmHg for >5min, ICP and CPP were averaged into epochs ranging from -5 to 120 minutes from each dose and compared to baseline (-5 to 0 min). RESULTS: High-frequency data were obtained from 33 pediatric severe TBI patients. We analyzed 136 doses of ketamine in 22 patients.  Of those, 10 doses were given for elevated ICP in 7 patients. ICP did not rise 1-10 minutes after ketamine doses. When given for ICP > 20mmHg, ICP was lower after ketamine doses (20-25 min, 16[14-21]; 25-30 min, 16[14-22]; 30-45 min, 15[14-20]; 45-60 min, 16[13-22]; 60-90min, 16[14-20]; 90-120min, 16[11-17] vs. -5-0 min, 25 [22-31]; median [IQR], Kruskal-Wallis, p < 0.05). CONCLUSIONS: In this pilot study, ketamine administration did not elevate ICP. When given for elevated ICP, we found preliminary evidence that ketamine may be associated with decreasing ICP. These findings warrant larger studies of ketamine’s effects on ICP in pediatric severe TBI.
Meta Tag
Content Type Presentation
Knowledge Area Neuroscience
Knowledge Area Pharmacology
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Traumatic Brain Injury TBI
Tag Analgesia and Sedation
Tag Pediatrics
Year 2022
Jennifer Laws
intracranial pressure
severe traumatic brain injury
pediatric TBI


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